Indicator Of Nutritional Status Research Articles

Transthyretin and Nutritional Status in Critically Ill Adults on Parenteral Nutrition: A Prospective Cohort Study.

Correctly characterizing malnutrition is a challenge. Transthyretin (TTR) rapidly responds to adequate protein intake/infusion, which could be used as a marker to identify malnutrition. Nutritional therapy is used to prevent malnutrition. Parenteral nutrition (PN) requires daily monitoring to determine whether what is being offered is adequate. This article aims to investigate whether the practice of measuring TTR is justified. Data from patients admitted to the ward or intensive care unit (ICU) were collected at three different times: within the first 72 h (T1) of PN use, on the 7th day (T2), and the 14th day (T3) after the initial assessment. 302 patients were included; the average age was 48.3 years old; the prevalence of death was 22.2%, and 61.6% of the sample were male. TTR values and the effectiveness of nutritional support in these patients were not associated with the outcome; however, meeting caloric needs was related to the outcome (p = 0.047). No association was found when TTR values were compared to the nutritional status. Thus, TTR was not a good indicator of nutritional risk or nutritional status in hospitalized patients. Undoubtedly, the TTR measurement was inversely proportional to CRP measurements. It was possible to conclude in this follow-up cohort of hospitalized patients that TTR values were not useful for determining whether the patient was malnourished, predicting death or effectiveness of nutritional support, yet based upon our analyses, a decrease in TTR greater than 0.024 units for every 1 unit increase in CRP might be due to ineffective nutritional supply.

Modifiable risk factors, oxidative stress markers, and SOD2 rs4880 SNP in coronary artery disease: an association study.

Coronary artery disease (CAD) has been linked to single nucleotide polymorphism (SNP) in superoxide dismutase 2 (SOD 2) gene. Additionally, several modifiable risk factors are also known to influence the CAD risk. To investigate the association between selected modifiable risk factors and oxidative stress markers with the SOD2 rs4880 SNP in CAD patients. A cohort of 150 angiographically confirmed CAD patients, and 100 control subjects in the same geographic area were enrolled. SOD levels and lipid peroxidation were assessed in the blood samples using standard protocols. The genotyping of the SOD2 gene was conducted through the PCR-sequencing method. This study indicated that CAD patients with the rs4880 SNP having heterozygous AG and mutated homozygous GG genotypes have increased oxidative stress, decreased SOD activity, and a positive association with CAD risk (OR 2.85) in comparison with control individuals. The investigation among CAD patients was then carried out based on modifiable risk factors. The risk factors selected were clinical characteristics, physical habits, nutritional status, and body mass index. In all the cases, MDA levels showed a positive association, and SOD activity showed a negative association with the selected polymorphism. The study suggests that the selected modifiable risk factors have an important role in the higher oxidative stress found in patients, which may lead to SOD2 polymorphism. It also suggests that the SOD2 locus can be identified as a marker gene for CAD susceptibility.

Digestible indispensable amino acid score (DIAAS): 10 years on.

The objective of the review is to revisit the findings of the 2011 Food and Agriculture Organization of the United Nations (FAO) Expert Consultation on Dietary Protein Quality Evaluation in Human Nutrition, and to report on progress on uptake of the findings. It is evident that since 2011 there has been a concerted research effort to enhance an understanding of the protein quality of foods. The validity of the growing pig ileal protein digestibility assay has been confirmed and numerous studies reported using the growing pig as a model to give true ileal amino acid digestibility values for foods as consumed by humans. This has allowed for the determination of digestible indispensable amino acid scores (DIAAS) for a range of foods. A new non-invasive true ileal amino acid digestibility assay in humans which can be applied in different physiological states, called the dual-isotope assay, has been developed and applied to determine the DIAAS values of foods. It is concluded that DIAAS is currently the most accurate score for routinely assessing the protein quality rating of single source proteins. In the future, the accuracy of DIAAS can be enhanced by improved information on: the ideal dietary amino acid balance including the ideal dispensable to indispensable amino acid ratio; dietary indispensable amino acid requirements; effects of processing on ileal amino acid digestibility and lysine bioavailability. There is a need to develop rapid, inexpensive in vitro digestibility assays. Conceptual issues relating DIAAS to food regulatory claims, and to holistic indices of food nutritional and health status are discussed. The first recommendation of the 2011 Consultation regarding treating each indispensable amino acid as an individual nutrient has received little attention. Consideration should be given to providing food label information on the digestible contents of specific indispensable amino acids.

The predictive value of GLIM criteria on clinical outcomes and responses to nutritional support in patients with neurocritical illnesses

Neurocritically ill patients frequently exhibit coma, gastroparesis, and intense catabolism, leading to an increased risk of malnutrition. The Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition was created to achieve a consistent malnutrition diagnosis across diverse populations. This study aimed to validate the concurrent and predictive validity of GLIM criteria in patients with neurocritical illnesses. A total of 135 participants were followed from admission to the neurocritical unit (NCU) until discharge. Comparing GLIM criteria to the Subjective Global Assessment (SGA), sensitivity was 0.95 and specificity was 0.69. Predictive validity of GLIM criteria was assessed using a composite adverse clinical outcome, comprising mortality and various major complications. Adjusted hazard ratios for moderate and severe malnutrition were 2.86 (95% CI 1.45–5.67) and 3.88 (95% CI 1.51–9.94), respectively. Changes in indicators of nutritional status, including skeletal muscle mass and abdominal fat mass, within 7 days of admission were obtained for 61 participants to validate the predictive capability of the GLIM criteria for the patients’ response of standardized nutritional support. The GLIM criteria have a statistically significant predictive validity on changes in rectus femoris muscle thickness and midarm muscle circumference. In conclusion, the GLIM criteria demonstrate high sensitivity for diagnosing malnutrition in neurocritically ill patients and exhibit good predictive validity.

Estimating Leaf Chlorophyll Content of Winter Wheat from UAV Multispectral Images Using Machine Learning Algorithms under Different Species, Growth Stages, and Nitrogen Stress Conditions

The rapid and accurate estimation of leaf chlorophyll content (LCC), an important indicator of crop photosynthetic capacity and nutritional status, is of great significance for precise nitrogen fertilization management. To explore the existence of a versatile regression model that can be successfully used to estimate the LCC for different varieties under different growth stages and nitrogen stress conditions, a study was conducted in 2023 across the growing season for winter wheat with five species and five nitrogen application levels. Two machine learning regression algorithms, support vector machine (SVM) and random forest (RF), were used to establish the bridge between UAV-derived multispectral vegetation indices and ground truth LCC (relative chlorophyll content, SPAD), taking the multivariate linear regression (MLR) algorithm as a reference. The results show that the visible atmospherically resistant index, vegetative index, and normalized difference vegetation index had the highest correlation with ground truth LCC, with a Pearson’s correlation coefficient of 0.95. All three regression algorithms (MLR, RF, and SVM) performed well on the training dataset (R2: 0.932–0.944, RMSE: 3.96 to 4.37), but performed differently on validation datasets with different growth stages, species, and nitrogen application levels. Compared to winter wheat species and nitrogen application levels, the growth stages had the greatest influence on the generalization ability of LCC estimation models, especially for the dough stage. At the dough stage, compared to MLR and RF, SVM performed best, with R2 increasing by 0.27 and 0.10, respectively, and RMSE decreasing by 1.13 and 0.46, respectively. Overall, this study demonstrated that the combination of UAV-derived multispectral VIs and the SVM regression algorithm could be successfully applied to map the LCC of winter wheat for different species, growth stages, and nitrogen stress conditions. Ultimately, this research is significant as it shows the successful application of UAV data for mapping the LCC of winter wheat across diverse conditions, offering valuable insights for precision nitrogen fertilization management.

PREVALENCE AND DETERMINANTS OF MALNUTRITION AMONG UNDER- FIVE CHILDREN OF HOUSEHOLD IN SLUM AREAS OF DISTRICT FAISALABAD

Malnutrition refers to a pathological condition characterized by a lack of nutrients necessary for healthy body function. Malnutrition is one of the most common causes of death and disease among children under the age of five. About 96% percent of children in Pakistan do not receive adequate nutrition during childhood, such as soft food, milk, fruit, and vegetables. Food insecurity is a serious problem in Pakistan as a significant portion of the rural population is food insecure. A staggering 36.9% of households in the country are 'food insecure' and 18.3% are 'severely' food insecure. Pakistan is self-sufficient in basic food items, but only 63.1% of households have food security. Food insecurity is common, leaving women and children at greater risk of malnutrition. Drought-affected communities have exceptionally high rates of malnutrition. According to statistics in Pakistan, about 40, 29%, and 18% of children under the age of five are a stunt, underweight, and wasted, respectively. Therefore, this study aims to investigate the prevalence and determinants of malnutrition status in children under 5 years of age in the slums of Faisalabad District, Punjab, Pakistan. The data is based on household demographic and socioeconomic factors, including anthropometric information on children under the age of five living in a slum in Faisalabad. Anthropometric data were obtained from 150 randomly selected children from three slum areas of Faisalabad. Socioeconomic and behavioural data were collected from each mother. Three indicators were used to measure the nutritional status of children: (i) stunting, height–for– age, (ii) wasting weight–for–height, and (iii) under-weight¸ weight–for–age. These values ​​were transformed into z-scores to classify the child's nutritional status. Descriptive and logistic regression techniques were used to identify factors associated with children's nutritional status. According to this study, the prevalence of stunting, being underweight, and wasting among children under five years of age in Faisalabad District, Pakistan were 28%, 22.6%, and 18% respectively. Testing with logistic regression techniques revealed that demographic, socio-economic, and behavioural factors were significant predictors of all three indicators of child nutritional status. These main factors were household calorie intake and maternal education, father education, access to clean water, and maternal access to health facilities.

Nutrient status and soil fertility index as a basis for sustainable rice field management in Madiun Regency, Indonesia

<p>Agricultural development, specifically for crops, contributes significantly to national development. However, problems with water and low soil fertility are obstacles to this development. This study evaluated the nutritional status and soil fertility index as the basis for determining the direction of rice field management in Madiun Regency, East Java, Indonesia. The research method was conducted by surveying the soil characteristics followed by laboratory analysis. Soil samples were collected using stratified proportional sampling from 19 land units with 31 samples. The soil fertility index was determined using a principal component analysis test and calculated by dividing the weights by the minimum soil fertility index indicators. The study results show that the nutritional status of total N in the study area is low to high (0.13%–0.59%) and total P is very low to very high (12.18–73.66 ppm), whereas the status of exchangeable K is very low to very high (0.01–0.67 cmol.kg<sup>−</sup><sup>1</sup>), Cation Exchange Capacity is low to high (12.8–36.0 cmol.kg<sup>−</sup><sup>1</sup>), and organic carbon is low to very high (1.98%–6.54%). The soil fertility index ranges from medium to extremely high. The influential indicators are total P, total N, exchangeable K, and organic carbon. It is recommended that the rice field management system implement a “sustainable agricultural intensification” system that combines the two systems “intensification” and “sustainable agroecosystem.” This system still uses proportional inorganic and organic fertilizers (manure, compost, and agricultural waste).</p>

Association of the modified Glasgow prognostic score and prognostic nutritional index with duration of oral anamorelin administration in patients with cancer cachexia: a retrospective cohort study.

The modified Glasgow Prognostic Score (mGPS) and Prognostic Nutritional Index (PNI) are indicators of nutritional status in cancer patients; however, the effects of baseline mGPS and PNI on the duration of administration of the ghrelin receptor agonist anamorelin, which is used to treat cachexia in patients with cancer, are unclear. This study aimed to clarify the association of mGPS and PNI with the duration of oral anamorelin administration for patients who did not have beneficial effects from anamorelin. The attending physician determined the duration of oral anamorelin administration based on discontinuation due to cancer progression, poor efficacy, adverse events, or death. The 12-week continuation rate of oral anamorelin was 30.4%. Univariate analysis revealed that an Eastern Cooperative Oncology Group performance status (ECOG-PS) of ≥2 (P<.001), concurrent chemotherapy (P=.002), albumin level (P=.005), C-reactive protein level (P=.013), and a mGPS of 2 (P=.014) were statistically significant predictors of the 12-week continuation rate of oral anamorelin. In the multivariate analysis, a mGPS of 2 remained a significant risk factor, and the ECOG-PS and concurrent chemotherapy had no effect on the association between the mGPS and 12-week continuation rate of oral anamorelin. Patients with a mGPS of 2, compared with mGPS of 0 or 1, are less likely to maintain oral anamorelin therapy, regardless of the ECOG-PS or concurrent chemotherapy. Therefore, it is necessary to consider initiating anamorelin administration at mGPS 0 or 1.

A correlation of serum fibroblast growth factor 21 level with inflammatory markers and indicators of nutritional status in patients with inflammatory bowel disease.

Fibroblast growth factor 21 (FGF21) is a stress-inducible hormone that regulates nutrient and metabolic homeostasis. Inflammatory state is one of the stimulators of FGF21 secretion. The aim of the study was to assess correlations between serum FGF21 level and inflammatory markers as well as nutritional status indicators in patients with inflammatory bowel disease (IBD). Fasting serum FGF21 level was measured using ELISA test in 105 IBD patients and 17 healthy controls. There were 31 subjects with active ulcerative colitis (UC), 16 with inactive UC, 36 with active Crohn's disease (CD), and 22 with inactive CD. Clinical and endoscopic activity of IBD was evaluated based on validated scales and indices. Fecal calprotectin, serum CRP, and selected parameters of nutritional status were tested in all patients. Serum FGF21 level was characterized by fluctuations depending on the IBD activity. FGF21 level was significantly higher in both active UC and CD compared to inactive phases of the diseases and to the controls. A correlation between FGF21 and fecal calprotectin levels was also found in UC and CD. Additionally, in CD, FGF21 level positively correlated with CRP level. In both UC and CD, a negative correlation was noted between FGF21 level and nutritional status parameters including cholesterol, protein, albumin levels, and BMI. The intensity of intestinal inflammation is related to FGF21 level, which correlates negatively with nutritional status indicators in IBD. The disturbances in FGF21 secretion may contribute to the multifactorial pathogenesis of malnutrition and weight loss in IBD patients.

Prognostic Nutritional Index (PNI) as Independent Predictor of Poor Survival in Prostate Cancer: A Systematic Review and Meta-Analysis

BackgroundThe concentration of albumin and lymphocyte in the body can serve as indicators of both nutritional status and inflammation. The predictive significance of the prognostic nutritional index (PNI) has been documented in multiple cancer types. Consequently, a meta-analysis was conducted in order to investigate the prognostic impact of PNI on survival outcomes among individuals diagnosed with prostate cancer. MethodsA systematic search was conducted across 4 electronic databases to identify pertinent studies that evaluated the predictive significance of pretreatment PNI in patients with prostate cancer. The outcomes of interest in this study were overall survival (OS) and progression-free survival (PFS). The researchers utilized random-effect models to summarize the time-to-event outcomes, presenting the results as adjusted hazard ratios (aHR) along with their corresponding 95% confidence intervals (CI). ResultsA total of 2229 prostate cancer patients in 13 studies were included. Pooled analysis from these studies showed that low PNI value was associated with shorter OS [aHR 1.99 (95% CI, 1.45-2.72), P < .0001], and PFS [aHR 1.97 (95% CI, 1.55-2.51), P < .00001]. Sub-group analysis revealed that the ability of PNI to predict poor outcomes was better observed in patients with metastatic castration-resistant prostate cancer (mCRPC) and those who received androgen receptor pathway inhibitors (ARPIs). ConclusionsThis study suggests the role of PNI in predicting the survival and progression of prostate cancer. PNI values can be used in the risk stratification of patients with prostate cancer.

No Evidence for Cross-Sectional or Longitudinal Associations between Cognitive Flexibility Performances and Nutritional Status in a Cohort of Inpatients with Anorexia Nervosa.

According to the Cognitive-Interpersonal model of anorexia nervosa (AN), the combined influence of cognitive and socio-emotional difficulties would constitute vulnerability and maintaining factors. Poor cognitive flexibility is one of the endophenotypic candidates (i.e., a trait marker) of the disorder, but few studies have examined its association with illness symptom variations, notably weight status. The study aimed to evaluate the relationships between cognitive flexibility performances and nutritional status indices (BMI; body composition) at different times of the disorder. Cross-sectional and longitudinal associations between cognitive flexibility (TAP 2.1) and nutritional status indices, along with anxious and depressive (HAD) and eating disorder (EDE-Q) symptomatology were investigated using univariate and multivariate analyses in a cohort of AN inpatients evaluated at hospital admission (N = 167) and discharge (N = 94). We found no or negligible associations between nutritional status and HAD or EDE-Q scores or cognitive flexibility performances, either cross-sectionally or longitudinally. Cognitive performances did not significantly differ between the AN subtypes. In agreement with the Cognitive-Interpersonal model of AN, cognitive flexibility is independent of nutritional status, as well as the AN subtype. It is also independent of the levels of anxious, depressive, or ED symptomatology. A new therapeutic approach targeting cognitive flexibility and intolerance to change could benefit severely emaciated people with AN, regardless of disease subtype and level of dysphoria.

Correlating male white‐tailed deer antler size with female body mass across multiple spatial scales

AbstractManagers use morphometric data collected from harvested animals as indicators of nutritional condition. Antler or horn size often are considered in ungulates, but there are problems associated with biased and limited harvest data available from male animals in many populations. Adult female body mass also may be collected, but little information exists on how male antler size scales with female body mass. We evaluated the relationship between property‐specific mature male white‐tailed deer (Odocoileus virginianus) antler size and adult female body mass from harvest data collected at 2 spatial scales. Regression predicted a 4.4‐cm increase in average mature male antler size for every 1‐kg increase in female body mass from 31 properties across the eastern United States, 2015–2023. Adult female mass explained 64% of the variation in mature antler size, and including latitude as a covariate did not improve model fit. When we considered data from 174 properties in Mississippi, USA, 1991–1994, we predicted a 4.7‐cm increase in average mature male antler size for every 1‐kg increase in adult female body mass. Including soil resource region in the Mississippi model explained 48% of the variation in mature male antler size by accounting for differences in average sizes across regions. Our results indicate average female body mass correlates with mature male antler size at multiple spatial scales. We recommend managers collect body mass and age from harvested female deer, as female mass represents a useful metric to track management progress and predict changes in antler size.

Estimation of Chlorophyll Content in Apple Leaves Infected with Mosaic Disease by Combining Spectral and Textural Information Using Hyperspectral Images

Leaf chlorophyll content (LCC) is an important indicator of plant nutritional status and can be a guide for plant disease diagnosis. In this study, we took apple leaves infected with mosaic disease as a research object and extracted two types of information on spectral and textural features from hyperspectral images, with a view to realizing non-destructive detection of LCC. First, the collected hyperspectral images were preprocessed and spectral reflectance was extracted in the region of interest. Subsequently, we used the successive projections algorithm (SPA) to select the optimal wavelengths (OWs) and extracted eight basic textural features using the gray-level co-occurrence matrix (GLCM). In addition, composite spectral and textural metrics, including vegetation indices (VIs), normalized difference texture indices (NDTIs), difference texture indices (DTIs), and ratio texture indices (RTIs) were calculated. Third, we applied the maximal information coefficient (MIC) algorithm to select significant VIs and basic textures, as well as the tandem method was used to fuse the spectral and textural features. Finally, we employ support vector regression (SVR), backpropagation neural network (BPNN), and K-nearest neighbors regression (KNNR) methods to explore the efficacy of single and combined feature models for estimating LCC. The results showed that the VIs model (R2 = 0.8532, RMSE = 2.1444, RPD = 2.6179) and the NDTIs model (R2 = 0.7927, RMSE = 2.7453, RPD = 2.2032) achieved the best results among the single feature models for spectra and texture, respectively. However, textural features generally exhibit inferior regression performance compared to spectral features and are unsuitable for standalone applications. Combining textural and spectral information can potentially improve the single feature models. Specifically, when combining NDTIs with VIs as input parameters, three machine learning models outperform the best single feature model. Ultimately, SVR achieves the highest performance among the LCC regression models (R2 = 0.8665, RMSE = 1.8871, RPD = 2.7454). This study reveals that combining textural and spectral information improves the quantitative detection of LCC in apple leaves infected with mosaic disease, leading to higher estimation accuracy.

Concerns over the Utility of Phase Angle and its Association with Muscle Function

Introduction: Phase angle (PhA) derived from bioelectrical impedance analysis (BIA) has been used as an indicator of cellular hydration, muscle function, and nutritional status. Positive relationships between PhA and various measures of muscle function have been reported but it remains unclear whether PhA retains its predictive utility of muscle function, or whether it performs better than fat-free mass (FFM) in the context of muscle function. Methods: This perspective highlights secondary analyses of data collected during a randomized, double-blind, placebo-controlled trial that examined indices of recovery with different whey protein supplements after muscle-damaging exercise among resistance-trained adults. Results: Bivariate correlations between phase angle and quadriceps twitch force were positively correlated at baseline, 24-h, and 72-h post-exercise. In linear regression, FFM was shown to account for nearly 44% (partial r = 0.662) of the variance in quadriceps twitch force independent of phase angle at 24-h. A similar pattern emerged at 48-h and 72-h post-exercise Conclusions: Within this framework, these data demonstrate that: 1) PhA exhibits a weaker correlation to quadriceps twitch force compared to FFM and 2) in the context of muscle function, PhA does not provide additional information beyond that of FFM alone. Investigators should consider adjusting for FFM when evaluating the relationship between PhA and muscle function outcomes.

Observation of the clinical characteristics of chronic diarrhea in children and evaluation of the prognostic value of nutritional and immune indicators

Objective: This research targeted to assess the clinical characteristics of chronic diarrhea in children, and explore the prognostic value of nutritional status and immune indicators. Methods: A total of 190 patients with chronic diarrhea from January 2017 to June 2020 were enrolled to analyze their epidemiology. The patients were divided into a better prognosis group (cured, improved) and a poor prognosis group (uncured), followed by determining the diagnostic efficacy of nutritional status and immune indicators in the prognosis of children with chronic diarrhea. Results: Most of the patients were 0-3 years old (74.2%), of which 54.3% were less than 1 year old, and the highest proportion (48.95%) had diarrhea with a course of 1 to 2 months. The levels of albumin, immunoglobulin G (IgG), IgA and IgM, as well as albumin, globulin and the ratio of albumin to globulin in the better prognosis group were higher than those in the poor prognosis group. The AUC (area under the curve) of the combined detection in evaluating the prognosis of children with chronic diarrhea was greater than that of the albumin and globulin alone (P &lt; 0.05). IgG ≥ 10.05g/L and IgA ≥ 7.72g/L were protective factors affecting the prognosis of children with chronic diarrhea. Conclusion: Children with chronic diarrhea are mainly infants and young children with various clinical symptoms, and are prone to comorbidities such as malnutrition, anemia, hypoalbuminemia, and impaired immune function. The combined detection of nutritional status and immune indicators in children is of value in evaluating the prognosis of children.

Prognostic value of anthropometric- and biochemistry-based nutrition status indices on blood chemistry panel levels during cancer treatment

Body weight, body mass index (BMI), Nutrition Risk Screening 2002 (NRS2002), and prognostic nutritional index (PNI) are among vital nutrition status indices employed during cancer treatment. These have also been associated with levels of blood chemistry panels (BCPs), which are touted as significant indicators of disease prognosis. However, it remains unclear which nutrition status index better predicts future trends in specific BCPs. Using the records of 407 cancer patients, we retrospectively examined the potential of nutritional status indices at baseline for predicting changes in specific BCPs over a 6-week period. Generally, both serum biochemical parameters and nutrition status indices fluctuated over the study period among study participants. PNI was often linearly associated with blood cell counts (white blood cells [WBCs] and hemoglobin) compared with anthropometric-based nutrition status indices. Increase in body weight was protective against having abnormal lymphocyte levels at 6 weeks (odds ratio [OR]: 0.960–0.974; CI: 0.935–0.997; P < 0.05), while increase in baseline PNI was associated with 0.865–0.941 and 0.675–0.915 odds of having future abnormal WBC and lymphocyte levels, respectively. Increases in PNI were also protective against having future abnormal albumin levels (OR: 0.734–0.886) and 8.5–12.5% decreases in the odds of having an abnormal C-reactive protein level in subsequent visits. Changes in NRS2002 tended to be associated with the odds of having future abnormal blood glucose levels. In conclusion, the serum biochemistry–derived nutrition status index, PNI, is a more consistent measure as an early indicator to track the trends of future changes in the BCPs of cancer patients. This implies that PNI could be targeted as an early-warning measure with relevant preventive interventions for patients at risk of malnutrition.

The effect of balanced energy-protein supplementation provided to lactating women on maternal and infant outcomes: study protocol for a prospectively planned individual patient data (IPD) meta-analysis

Abstract* Background The high prevalence of infant stunting and maternal undernutrition in low- and middle-income countries poses a significant public health threat. The World Health Organization recommends balanced energy-protein (BEP) supplementation to pregnant women from populations with a high prevalence of underweight (prepregnancy BMI &lt;18.5 kg/m2), leaving a notable gap in guidance for lactating women. Therefore, we established the Maternal BEP Studies Harmonization Initiative (BEP Initiative) to investigate the impact of BEP supplementation given to pregnant and/or lactating women on maternal and infant outcomes by synthesizing data from multiple clinical trials. This is a study protocol for our prospective individual participant data (IPD) meta-analysis on BEP lactation trials. Methods Data from four randomized controlled trials that include mother-infant dyads in India (n=816), Pakistan (n=957), Burkina Faso (n=800), and Nepal (n=726) will be pooled and analysed. Women were randomized to BEP (one trial had a third arm with maternal BEP plus infants receiving azithromycin) or control groups at baseline (during the first week) and received the intervention through six months postpartum. A one-stage IPD meta-analysis will be done using mixed-effects linear and log-binomial regression models to account for between-trial heterogeneity. The primary outcome of infant length-for-age z scores (LAZ) and secondary outcomes of maternal and infant indicators of nutritional status, all at six months of age, will be examined. Also, we will assess baseline characteristics as covariates and effect modifiers for the BEP to outcome relationship. Discussion This prospective IPD meta-analysis uses a one-stage IPD meta-analysis, which allows for higher statistical power to examine outcomes, more flexibility in defining variables, and can examine effect modifiers, which could inform which individuals or populations may benefit more from BEP given during lactation.

Open Defecation, Livestock Ownership, and Child Nutritional Status in India.

South Asian children are among the most severely malnourished worldwide. One prominent hypothesis is that open defecation in the local area exposes children to human fecal pathogens that can cause diarrhea and malnutrition. Much of the existing research uses district-level measures of open defecation, which could mask important local-area variation. A second hypothesis is that animal fecal matter is a major source of exposure. This analysis tested these dual hypotheses using census data collected from 949 villages in Tamil Nadu, India, and a survey conducted in a random sample of 5,000 households in the same area. The final analytic sample consisted of 2,561 children aged 0-10 years. We estimated the association between the measures of village- and household-level open defecation, household livestock ownership, and child height-for-age Z-scores in a regression framework, controlling for potential confounders. Results revealed that village- and household-level open defecations are negatively associated with child height. There was an estimated difference of approximately 0.5 height-for-age Z-score between children living in villages with no open defecation and children in villages where all households practiced open defecation (P = 0.001) and a 0.2 Z-score difference between children living in households that practiced open defecation and those living in households that did not (P = 0.001). Livestock ownership was not associated with child height. Overall, the findings provide evidence on the centrality of open defecation in explaining persistent child malnutrition in India and the higher risk of exposure to human fecal pathogens compared with animal feces in the south Indian context.

Nutritional Status Indicators Predict Tolerability to Adjuvant Chemotherapy in Patients with Stage II/III Rectal Cancer Undergoing Neoadjuvant Chemoradiotherapy

Introduction: Adjuvant chemotherapy (AC) after radical surgery following preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) is now the standard of care. The identification of risk factors for the discontinuation of AC is important for further improvements in survival. We herein examined the prognostic impact of chemotherapy compliance and its relationship with the prognostic nutritional index (PNI) before surgery. Methods: A total of 335 stage II–III LARC patients who underwent preoperative CRT between 2003 and 2022 at the University of Tokyo Hospital were retrospectively reviewed. We excluded patients with recurrence during AC and those who had not received AC. The relationship between AC and long-term outcomes and that between PNI values and the duration of AC were examined. Results: Thirty-one patients discontinued AC and 62 continued AC. Recurrence-free survival (RFS) was significantly shorter in patients who discontinued AC (p = 0.0056). The discontinuation of AC was identified as an independent risk factor for RFS (hazard ratio [HR]: 2.24, p = 0.0233). Twenty-one patients were classified as having low PNI (less than 40), which correlated with an older age, low body mass index, and incomplete AC. Low PNI was an independent risk factor for a shorter duration of AC (HR: 2.53, p = 0.0123). Conclusion: The discontinuation of AC was related to poor RFS in patients with LARC undergoing preoperative CRT. Furthermore, a low PNI value was identified as a risk factor for a shorter duration of AC.

#2896 Malnutrition is prevalent in hemodialysis patients—results from Croatian multicenter hemodialysis study

Abstract Background and Aims Malnutrition is a usually observed condition among patients on hemodialysis (HD) and is considered one of studiest indicators of mortality and morbidity. Malnutrition inflammation score (MIS) is associated with inflammation, nutritional status, quality of life, and 5-year prospective mortality. Also, phase angle (PhA) measured by bioelectrical impedance analysis (BIA) has been studied as indicator of nutritional status or muscle function in HD patients and lower PhA was associated with a greater risk of malnutrition. The aims of this study are to analyze the prevalence of malnutrition in hemodialysis (HD) patients in Croatia using MIS, and to assess the association of MIS and PhA with body mass composition, sociodemographic characteristics and laboratory parameters related to HD. Method 166 HD patients aged 68.5 (58.8-76) years, 55 women (33%) and 111 (67%) men with mean HD duration of 4 (2-6) years from 6 HD center were included in this study. For each study participant, data about body composition measured with BIA, laboratory, sociodemographic and clinical parameters were obtained. Also, body mass index (BMI) was calculated, and the Malnutrition Inflammation Score (MIS) used to assess nutritional status. Results Using an MIS cut-off point of 5 for malnutrition, 53% of patients were malnourished (MIS≥5). Therefore, those malnourished HD patients were significantly older (p = 0.001), with longer HD duration (p = 0.002), lower residual renal function (p = 0.02), waist circumference (p = 0.001), BMI (p &amp;lt; 0.001), muscle (p = 0.002) and fat mass (p = 0.001) in kg, phase angle PhA (p &amp;lt; 0.001), serum creatinine (p = 0.002), albumin (p = 0.008), phosphate (p = 0.01), and urate (p = 0.008) level but have significantly higher ferritin (p = 0.004), and mean cellular volume level (p = 0.02). Therefore, total MIS score significantly negatively correlated with HD duration (r = −0.247, p &amp;lt; 0.001), waist circumference (r = −0.323, p &amp;lt; 0.001),muscle mass (r = −0.236, p &amp;lt; 0.001), fat mass (r = −0.352, p &amp;lt; 0.001), serum creatinine (r = −0.271, p &amp;lt; 0.001), phosphor (r = −0.245, p &amp;lt; 0.001), urate (r = −0.344, p &amp;lt; 0.001), and TIBC (r = −0.376, p &amp;lt; 0.001), albumin (r = 0.241, p &amp;lt; 0.001), ferritin (r = 0.273, p &amp;lt; 0.001). In contrast, PhA significantly positively correlated with muscle mass (kg) (r = 0.311, p &amp;lt; 0.001), creatinine (r = 0.313, p &amp;lt; 0.001), phosphate (r = 0.208, p = 0.01), urate (r = 0.305, p = 0.01) and Total Iron Binding Capacity (TIBC) (r = 0.245, p &amp;lt; 0.001) while significantly negative correlation with ferritin (r = −0.182, p = 0.03) was found. Also, there was a significant negative correlation between PhA and MIS (r = −0.362, p &amp;lt; 0.001). A multivariate regression analysis showed that age (ß = 0.09, p = 0.005), waist circumference (ß = −0.09, p = 0.004), serum albumin (ß = −0.23, p = 0.04), and urate (ß = −0.01, p = 0.02), were predictive factors for malnutrition. Conclusion The prevalence of malnutrition in HD patients in Croatian HD population was high. These results indicate and highlight the urgent need for individualized and structural nutritional screening (using MIS score and PhA) and nutritional support in Croatian HD patients, especially for older HD patients and those with longer HD duration.